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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by tom2228 on April 6, 2014, at 21:35:16
I've been taking nortriptyline for almost a week now, titrating to 75mg tonight, and am pleased with the therapeutic results so far (!!).
However, I prize my intellect and need a clear mind to succeed in school, and it seems nortriptyline is doing a number on my cognitive abilities. I understand it's early in my trial and that things may improve, but I do not necessarily like the idea of getting "used to" or acclimating to this state of cognitive functioning. I need as much clarity as I can get.
So, I understand the negative effect on cognition stems in part from the nortriptyline's antihistamine and from its antimuscarinic effect.
I have heard of bethanechol (urecoline), a muscarinic agonist, as being helpful for antimuscarinic effects such as urinary retention and dry mouth, but what about for cognitive impairment?
I saw somewhere that it may not be helpful as it is does not cross the blood-brain barrier, but am interested in your thoughts and experiences.
Otherwise if notrtrip doesn't work out I was thinking desipramine might be better in the sense that the lower potency for muscarinic and histamine receptors would confer an advantage for cognition.
Thanks
Posted by tom2228 on April 6, 2014, at 22:21:42
In reply to bethanechol for TCA-induced cognitive impairment?, posted by tom2228 on April 6, 2014, at 21:35:16
from wikipedia:
"Its potential benefit in the treatment of cerebral palsy has been investigated.[1] Bethanechol is a powerful cholinergic agent which does not cross the blood - brain barrier and may have powerful nootropic properties in enhancement of neural signaling and processing speed as well."
Is it me or does the last sentence seem to contradict itself? How can it have nootropic properties without crossing the BBB?
Posted by g_g_g_unit on April 7, 2014, at 1:19:49
In reply to Re: bethanechol for TCA-induced cognitive impairment?, posted by tom2228 on April 6, 2014, at 22:21:42
You could always try supplemental choline, or something like Galantamine.
Posted by phidippus on April 11, 2014, at 13:48:07
In reply to Re: bethanechol for TCA-induced cognitive impairment?, posted by tom2228 on April 6, 2014, at 22:21:42
Sorry to say but the jury is still out on Bethanechol helping with any cognitive process.
Try Keppra-it has shown to improve cognitive function. http://bipolarnews.org/?p=883
Eric
Posted by LouisianaSportsman on April 17, 2014, at 3:31:50
In reply to bethanechol for TCA-induced cognitive impairment?, posted by tom2228 on April 6, 2014, at 21:35:16
I wouldn't suggest nortriptyline tirtration above 100mg. then with your side effects. Forward, blood plasma testing is advised.
I would titrate to 100mg. notriptyline max until you've tried it along with up to a maxed out modafinil dose, e.g. Nuvigil trialed at a least 250mg. or Provigil at 600mg. It's a nootropic that directly relieves the histaminergic effect of nortriptyline by countering it pharmacological. I think it should be first-line treatment for anyone taking TCAs experiencing your cognitive problem or sedation.
Posted by tom2228 on April 17, 2014, at 15:09:23
In reply to Re: bethanechol for TCA-induced cognitive impairment?, posted by LouisianaSportsman on April 17, 2014, at 3:31:50
> I wouldn't suggest nortriptyline tirtration above 100mg. then with your side effects. Forward, blood plasma testing is advised.
>
> I would titrate to 100mg. notriptyline max until you've tried it along with up to a maxed out modafinil dose, e.g. Nuvigil trialed at a least 250mg. or Provigil at 600mg. It's a nootropic that directly relieves the histaminergic effect of nortriptyline by countering it pharmacological. I think it should be first-line treatment for anyone taking TCAs experiencing your cognitive problem or sedation.I have thought about this and think it is a fantastic idea on paper. I'm afraid of modafinil though because it being an inhibitor of the DAT would inhibit methamphetamine-mediated dopamine release and thereby block my Desoxyn. nortriptyline, being an NET, already does this with the norepinephrine side of things -- my focus IS off, but that may not be due to this and may be due to the side-effects instead.
although I am still spacey, I think I am going to ask for an increase to 100mg today because the AD effects of my combo have seemed to diminish to an extent.
if 100mg is intolerable then I guess a switch to desipramine would be better for less antihistamine and antimuscarinic effects.
being on less Marplan now may explain my spaciness too, as it increases my baseline attention and potentiates Desoxyn. maybe going up to 40mg or back to 50mg would help.
as well, thinking of taking you suggestion and asking for Namenda XR in place of Mirapex ER
This is the end of the thread.
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